Healthy Nations Initiative

Norton Sound Health Corporation

About the Program

Norton Sound Health Corporation (NSHC), an Alaskan Native health organization serving the comprehensive health needs of twenty tribal entities in the remote Bering Strait region of Alaska, proposes to extend and broaden the activities of the Healthy Nations program funded through the Robert Wood Johnson Foundation.

NSHC proposes to build upon the successes of the two year development phase of the Healthy Nations program in which programs to increase public awareness of substance abuse, and stimulate the development of comprehensive prevention, early intervention, treatment, and after-care services have been piloted. NSHC is confident that the Healthy Nations program is prepared to move forward and implement the second phase of the project beginning in December 1995. The overall philosophy of the Healthy Nations project can be expressed as follows: Building on the inherent strengths of our cultural values, the Healthy Nations Project shall empower our tribes to promote healthy children, families and communities.

Consistent with this philosophy, the Healthy Nations project proposes to:

Implement a variety of culturally relevant public awareness campaigns designed to increase public awareness of the dangers of inhalant, tobacco, marijuana, cocaine, and alcohol use.

Support a comprehensive set of activities for the region’s youth designed to promote pride in cultural heritage and prevent substance abuse, including youth leadership training, peer counseling support and promotion, cultural education activities, outdoor adventure training, and substance abuse education.

Support the efforts of parents, families and communities to provide positive environments for children and youth through the provision of parent education and training, and coordination of regional services to parents.

Extend the range of accessible substance abuse prevention and treatment services to Bering Strait communities through training and support of teleconference AA and ALANON meetings, promotion and education of existing services, and interagency coordination of services.

Promote early identification of substance abuse problems through a variety of educational activities for people of all ages.

Document models of healthy living and successful health promotion activities that inspire and promote changes in behavior.

Promote the capacity of the villages of the region to plan and implement activities that address the unique needs of their villages.

NSHC is confident that successful implementation of a variety of programs coordinated with the efforts of concerned people and agencies of the region will result in a significant stride toward the eradication of substance abuse in the region.

Host Community/Organization

The Bering Strait Region of Northwest Alaska, the area served by this project, encompasses about 44,000 square miles. It includes the villages of Brevig Mission, Diomede, Elim, Gambell, Golovin, Koyuk, St. Michael, Savoonga, Shaktoolik, Shishmaref, Stebbins, Teller, Unalakleet, Wales and White Mountain as well as the region’s hub city of Nome. The Region extends from the Northern tip of the Seward Peninsula to the southern shores of Norton Sound. It also includes St. Lawrence Island and Little Diomede Island, the latter being only about two miles from Russian soil and twenty-five miles from the Russian mainland.

Nome is the transportation, commercial and service hub of Northwest Alaska. Located about 500 miles from Anchorage, it is accessible to other urban areas of the state only by air (year round) and sea (summers only). Nome is famous as a turn of the century gold rush town and was once Alaska’s largest city. Its image as a rowdy town is kept alive in the American consciousness by the songs of that era. The City played a strategic role in the air war against Germany in W.W.II. Today, Nome is most famous as the end of the 1,049 mile Iditarod Sled Dog Race held each year in March. During this time, the town takes on an air of an arctic Mardis Gras. Public drunkenness is quite common.

Gold mining is still a part of the Nome economy, although it has diminished in importance. Individuals still come north to stake their claim, but most mining is done by larger, industrial concerns. Today, government (federal, state and local) is the biggest employer in the region. A sizable number of other jobs is classified as service positions, but are directly dependent on government funding. The private economy revolves around the mostly seasonal industries of commercial fishing, construction, tourism, and, of course, gold mining. Alaska’s reindeer industry is centered in the Nome area and is a source of seasonal income for the Native population.

Village economies are a hybrid of cash and subsistence. Many residents still live a traditional lifestyle; relying on the land and sea for most of their food. While subsistence is a centuries old way of living, modern adaptations have been made. Snowmobiles have replaced dogsleds, and firearms have replaced more primitive weapons. Part-time and seasonal employment helps to buy bullets, gasoline and other necessary provisions. Some residents obtain cash by selling traditional wares such as ivory carvings and baskets. Employment opportunities in the villages are limited.

Income statistics for the region contradict the common notion that Alaskans are well off financially. The state has a per capita income of $17,601, the fourth highest in the nation; however, the Nome Census Area has a per capita income of only $10,701. Most disturbing is that per capita income for the region’s Native population averages only $6,373. This number is far below those for non-metropolitan areas of Alabama, Mississippi and Louisiana, often thought to be the poorest in the country.

Low incomes are strained by the region’s high cost of living. Nome prices are roughly double those of the Lower 48. For some of the more remote villages, the cost of living is triple that of the rest of the U.S. While it is true that subsistence helps to guarantee that families have food, many residents of the region simply cannot afford essential goods and services. Among these are electricity and water and sewer, basic necessities of a modern life. Living conditions in some villages rival those of third world countries.

The Bering Strait Region has a total population of 8,288 persons, of which 6,337 (76.5%) are Native (according to 1990 Census data). The relatively small population is spread out over a vast geographic distance. Most Natives in the region belong to one of three culturally and linguistically distinct groups of Eskimos who are indigenous to the region: Inupiat, Central Yupik and St. Lawrence Yupik.

Accomplishments

Strategy 1: Public Awareness Campaign

The Norton Sound Health Corporation Healthy Nations project conceived to help the people of Northwestern Alaska, a very large territory covering some 44,000 square miles accessible only by air transport and serving 20 Native Alaskan villages or campsites.

The first principle goal, creating a public awareness campaign, included significant outreach and creativity. Initially, this goal targeted only 2 villages. This effort soon demonstrated that with the region-wide resources; local cable channel, newspapers, two radio stations, a more comprehensive information dissemination scope was possible. After the first year, based on a Visioning Workshop, the goal was changed to include the whole region. Consonant with the culture in the region, many direct local projects were incorporated into this campaign. Visits to numerous villages where meetings and demonstrations were held to promote healthy lifestyle in particular anti-drinking and smoking seminars transpired. Using a video created the year before, "A Time To Quit", coordinated showings and discussions were held in at least five villages. These discussions targeted the youth, a group that exceeds the national average in problems with substances.

Over the years, Healthy Nations utilized the airways, newsprint and local cable channel to get pro-health messages out to the public. Public Service Announcements (PSA), like inhalant dangers in March of each year, Drug and alcohol awareness during October red ribbon weeks, ten reasons to stop smoking, drug related birth defect awareness, child abuse prevention, how to access treatment, and many other examples. The PSAs were broadcast regionally and multiple times during a period. It is estimated that they were heard by 1/2 of the population or 5,000 people.

Another source of public information was the use of the hospital based bulletin board. Prominently visible in the main hall of the only medical facility in the region, the messages were viewed by approximately 3000 per quarter. Topics covered were healthy traditional foods, exercise and health, talking with you physician about you drug use, domestic violence and prevention, parenting skill and general information on accessing treatment and support for recovery. These bulletin boards were maintained by Healthy Nations staff and rotated quarterly.

The hands-on conferences and multi-agency efforts targeted the Native Youth Leadership Organization, village leaders, service providers and Elders in the region. Conferences on "Cross Cultural Relations" "Grieving Loss of Culture" and Taking Back Our Communities" have been region-wide events sponsored by Healthy Nations. Numerous local and community workshops, meetings and conferences were held over the years addressing topics from bike safety to inhalant abuse. These conferences utilized local agencies, talent and youth in their preparation and delivery. Many of these events would not have occurred without the Healthy Nations project.

Strategy 2: Community-Wide Prevention

The goal to stimulate a children and youth oriented prevention program was a consistent focus during the life of the grant. Initially, working closely with community resources, the Native Youth Leadership Organization, village youth groups and the school districts, the Healthy Nations project sponsored training and held workshops. Topics like drug abuse prevention, relationships, stay in school, safe sex, Native traditions, living in two cultures and self-esteem were provided. Youth camps, association with statewide conferences and programs, celebration of national events, and local positive competitions and events were attended by youth and youth leaders as sponsored by Healthy Nations. Trainings and workshops were organized to increase youth leaders, parents, and concerned volunteer's skills and knowledge. Trainings on identification of abuse, parenting skills and suicide prevention were held. Many of these projects were joint activities combining resources and expertise from State, local and Behavioral Health specialists. The interagency coalition provided a dialogue to address the youth and children of the region. Such events pulled together the local agencies and interested parties into a joint focus and purpose.

Another avenue for getting prevention information to the public was through the use of multimedia sources. Many newspaper articles, Public Service Announcements and public displayed bulletin board messages were used and previously documented to the NPO. This method had the potential to touch every household in the region. Especially effective were the hospital-based bulletin boards that reminded individuals of issues surrounding alcohol and healthy choices. Every month, hundreds of hospital patrons would be exposed to the message. These boards also helped to remind other providers of the integrated and intimate nature of substance use and broader medicine.

The third method incorporated was a large regional conference that spotlighted Indigenous ways for healing and a call for community and local leadership change to stop the death and destruction caused by alcohol. This conference, "Taking Back Our Communities" was held in Nome and was attended by representatives for every village. The community at large was privileged to attended powerful teaching/entertainment by American Indian leaders, First Nation speakers and a musical group focusing on sobriety.

The fourth method utilized was by creating and going live with a web page cataloguing all the prevention/intervention materials available at Behavioral Health Services. This link is accessible in every village across the Norton Sound intranet and is also hot linked with other resources sites. This has the possibility of impacting each village and all providers in the region. Such a resource library will enhance access and utilization of material for prevention and community efforts. The Healthy Nations sponsored online resource library has dramatically provided greater public access to information and materials. The integration of the Healthy Nations within the great Behavioral Health Services has facilitated more prevention activities provided by the clinical and village based counseling staff. The public continues to get strong message about sobriety and healthy choice through inclusion of some Healthy Nations doctrine.

Strategy 3: Early Identification, Intervention and Referral

Initially, the Healthy Nations project focused on coordination with the local substance abuse delivery system. Mostly training of local individuals and meeting dealing with the lack of services were completed. In the last three years of Healthy Nations being more institutional and integrated, the amount of services in each village has increased tremendously.

Some activities cross all the principle goals and specific objectives. Early in the grant, the Healthy Nations coordinator wrote and used a Native Parenting Guide. This very thoughtful and important document is currently being integrated into a region wide Alaska Youth Initiative/Development Disabilities program. A video created on stopping smoking and one on inhalant abuse is available in the resource library. The conferences previously talked about informed the community, the leadership and the clients about important issue attending the general well-being of the region. The trainings and sponsoring of youth and leaders to workshops continue to affect the region. While these individuals do not work directly for Behavioral Health Services or Healthy Nations, the information and skills are being utilized in other service agencies in the region. Finally, the basic philosophy of Healthy Nations permeated and informed a solid and impressive evolution to a model of services and prevention that is culturally responsive, meaningful and sustainable.

Strategy 4: Substance Abuse Treatment and Relapse Prevention

Over the time of the grant, this goal was revised from seeking volunteerism in the communities to the integration of services with a para-professional Village-Based Counselor. In fact, the direct leadership of the grant was subsumed under the VBC director to help facilitate this integration. Because drug and alcohol problems coupled with the depression and mental health issues pervading the region were extensive, Healthy Nations wished to provide a local resource to help facilitate early help. This foundational philosophy was crucial in the subsequent growth of the Village Based Counseling program as part of the integrated Behavioral Health Services programs. Healthy Nations provided material, trainings and support for the structured and operations of the VBC program.

With the VBC program, routine itineration, support of local community readiness projects and access to a resource library is continuing to be addressed. Four villages currently have an AA-type group, most have VBC/ Healthy Nations sponsored youth and specialty groups. Great effort to coordinate and share resources in the villages has helped to decrease the isolation and lack of local capacity. Healthy Nations sponsored the Community Readiness Survey and program in three villages. While all villages took the survey, only these three actively pursued creating community change using this model. This aspect of development has informed many of the VBC events and tribal interactions.